Buttress brachytherapy and integrated staple line markers for margin identification

ABSTRACT

A surgical buttress for use in a surgical stapling apparatus is provided. The surgical buttress includes an elongate rectangular body portion defining a width; a nose portion integrally formed with and extending from a distal end of the body portion, the nose portion defining a width that is less than the width of the body portion; a neck portion integrally formed with and extending from a distal end of the body portion, the neck portion defining a width; a head portion integrally formed with and connected to a distal end of the neck portion, the head portion defining a width; and a tail portion integrally formed with and extending from a proximal end of the body portion, the tail portion defining a width that is less than the width of the body portion. The surgical buttress is formed from a material having filaments. The surgical buttress include radioactive material.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of and priority to U.S. ProvisionalPatent Application No. 61/992,520, filed May 13, 2014, the entiredisclosure of which is incorporated by reference herein.

The present application is a Continuation-in-Part Application claimingthe benefit of and priority to U.S. patent application Ser. No.14/163,386, filed on Jan. 24, 2014, which is a Continuation-in-PartApplication claiming the benefit of and priority to U.S. patentapplication Ser. No. 13/955,341, filed on Jul. 31, 2013, which is aContinuation-in-Part Application claiming the benefit of and priority toU.S. patent application Ser. No. 13/419,565, filed on Mar. 14, 2012(U.S. Pat. No. 8,561,873), which is a Continuation Application claimingthe benefit of and priority to U.S. patent application Ser. No.12/579,605, filed on Oct. 15, 2009 (U.S. Pat. No. 8,157,151), the entirecontent of each of which is incorporated herein by reference.

U.S. patent application Ser. No. 13/955,341 also claims the benefit ofand priority to U.S. Provisional Patent Application No. 61/696,906,filed Sep. 5, 2012, the entire disclosure of which is incorporated byreference herein.

BACKGROUND

1. Technical Field

The present disclosure relates to a surgical stapling apparatus and,more particularly, to a surgical stapling apparatus including adetachable surgical buttress for an anvil and a staple cartridge.

2. Background of Related Art

Surgical stapling instruments that are used to sequentially orsimultaneously apply one or more rows of fasteners to join segments ofbody tissues are well known in the art. The fasteners are typically inthe form of surgical staples but two part polymeric fasteners can alsobe utilized. Such devices generally include a pair of jaws to clamptherebetween the body tissues to be joined. Typically, one of the jawmembers includes a staple cartridge which accommodates a plurality ofstaples arranged in at least two lateral rows while the other jaw memberhas an anvil that defines a surface for forming the staple legs as thestaples are driven from the staple cartridge.

When the stapling instrument is actuated, longitudinally translatingcams contact staple drive members in one of the jaws which in turn actsupon staple pushers to sequentially or simultaneously eject the staplesfrom the staple cartridge. A blade can travel between the staple rows tolongitudinally cut and/or open the stapled tissue between the rows ofstaples. Such instruments are disclosed, for example, in U.S. Pat. No.3,079,606 and U.S. Pat. No. 3,490,675.

When stapling relatively thin or fragile tissues, it is important toeffectively seal the staple line against air or fluid leakage.Additionally, it is often necessary to reinforce the staple line againstthe tissue to prevent tears in the tissue or pulling of the staplesthrough the tissue. One method of preventing tears or pull throughinvolves the placement of a biocompatible fabric reinforcing material,or a “buttress,” between the staple and the underlying tissue. In thismethod, a layer of buttress material is placed against the tissue andthe tissue is stapled in conventional manner. In more recent methods,the layer of buttress is positioned on the stapling instrument itselfprior to stapling the tissue. Some surgical staplers utilize fastenersor clips to temporarily connect buttress material to each of the jaws ofthe staplers, i.e., one disposed on the staple cartridge assembly andthe other on the anvil assembly.

WO 2008/109125 discloses a surgical stapling apparatus that includes acartridge assembly, an anvil assembly, and a surgical buttressreleasably secured by an anchor. The anchor releases the surgicalbuttress during firing of the stapling apparatus.

It is a desire of the present application to provide surgical staplingapparatus with a surgical buttress secured thereto in a manner thatminimizes shifting of the surgical buttress, and tearing or other damageto the surgical buttress during assembly. It would also be desirable toprovide a single profile buttress that can be used on a surgical staplecartridge assembly and/or a surgical anvil cartridge assembly, as wellas cartridge and anvil assemblies of different sizes. Accordingly, it isan object of this disclosure to meet the aforementioned desires.

SUMMARY

The present disclosure relates to a surgical stapling apparatusincluding a surgical buttress.

According to an aspect of the present disclosure, a surgical staplingapparatus is provided and includes a cartridge assembly defining a firsttissue contacting surface, the cartridge assembly housing a plurality ofsurgical fasteners therein, the cartridge assembly defining at least onedistal attachment point and at least one proximal attachment point; ananvil assembly defining a second tissue contacting surface, the anvilassembly movably secured in relation to cartridge assembly, the anvilassembly defining at least one distal attachment point and at least oneproximal attachment point, wherein the at least one proximal attachmentpoint of the anvil assembly is offset an axial distance from the atleast one proximal attachment point of the cartridge assembly; and asurgical buttress releasably secured to each of the first tissuecontacting surface and the second tissue contacting surface, thesurgical buttress including a body portion configured to substantiallyoverlie at least one of the first and second tissue contacting surfacesof either the first length and second length cartridge assembly andanvil assembly.

Each surgical buttress defines a distal attachment feature forregistration with the distal attachment point of the cartridge assemblyand the anvil assembly; and a first proximal attachment feature and asecond proximal attachment feature offset an axial distance from thefirst proximal attachment feature. The first proximal attachment featureregisters with the proximal attachment point of the cartridge assembly;and the second proximal attachment feature registers with the proximalattachment point of the anvil assembly.

The surgical buttress may be disposed against the tissue contact surfaceof the cartridge assembly and the surgical buttress may be disposedagainst the tissue contact surface of the anvil assembly havesubstantially the same length.

Each surgical buttress may have the same configuration. Each surgicalbuttress may be fabricated from a biocompatible and bioabsorbablematerial.

The surgical stapling apparatus may further include sutures retainingsurgical buttresses against the tissue contacting surface of thecartridge assembly and the anvil assembly.

The surgical stapling apparatus may further include a suture retaining adistal end portion of the surgical buttress against a respective one ofthe cartridge assembly and the anvil assembly, wherein the suturemaintains the distal attachment feature of the surgical buttress inregistration with the distal attachment point of the respective one ofthe cartridge assembly and the anvil assembly.

The surgical stapling apparatus may further include a suture retaining aproximal end portion of the surgical buttress against a respective oneof the cartridge assembly and the anvil assembly, wherein a suturemaintains the first proximal attachment feature of the surgical buttressin registration with the proximal attachment point of the cartridgeassembly and the anvil assembly, and wherein a suture maintains thesecond proximal attachment feature of the surgical buttress inregistration with the proximal attachment point of the anvil assembly.

According to another aspect of the present disclosure, a surgicalstapling apparatus is provided and includes a cartridge assemblydefining a first tissue contacting surface, the cartridge assemblyhousing a plurality of surgical fasteners therein, the cartridgeassembly being either a first length or a second length longer than thefirst length; an anvil assembly defining a second tissue contactingsurface, the anvil assembly movably secured in relation to cartridgeassembly, the anvil assembly being either the first length or the secondlength each corresponding to the length of the cartridge assembly; and asurgical buttress releasably secured to at least one of the first tissuecontacting surface and the second tissue contacting surface, thesurgical buttress including a head portion, a neck portion, and a bodyportion. The head portion is connected to a distal end of the bodyportion by the neck portion. The surgical buttress is configured tosubstantially overlie at least one of the first and second tissuecontacting surfaces of either the first length and second lengthcartridge assembly and anvil assembly.

The body portion of the surgical buttress may define a recess formed ina proximal edge thereof, the recess longitudinally bisecting theproximal edge. The recess may be a notch having a v-shape profile.

The body portion of the surgical buttress may define at least one pairof opposing proximal recesses, and each of the at least one pair ofopposing proximal recesses may be formed on an opposing lateral side ofthe body portion near a proximal edge of the surgical buttress. The atleast one pair of opposing proximal recesses may be a notch having av-shape profile.

The body portion of the surgical buttress may further define a pair ofopposing distal recesses, and each of the pair of opposing distalrecesses may be formed on an opposing lateral side of the body portionnear a distal edge of the body portion.

The pair of opposing distal recesses may be longitudinally tapered. Adistal edge of the body portion of the surgical buttress may be arcuate.A distal edge of the body portion of the surgical buttress may have atransverse width dimension that is less than that of the rest of thebody portion. The head portion may have a substantially rectangularshape.

Each surgical buttress may be fabricated from a biocompatible andbioabsorbable material.

According to a further aspect of the present disclosure, a surgicalbuttress for use in a surgical stapling apparatus is provided. Thesurgical buttress includes a body portion; a neck portion; and a headportion connected to a distal end of the body portion by the neckportion, wherein the body portion defines at least one pair of opposingproximal recesses, each of the at least one pair of opposing proximalrecesses is formed on an opposing lateral side of the body portion neara proximal edge of the body portion.

Each of the at least one pair of opposing proximal recesses may be anotch having a v-shape profile. The body portion may further define apair of opposing distal recesses, each of the pair of opposing distalrecesses may be formed on an opposing lateral side of the body portionnear a distal edge of the body portion.

The body portion of the surgical buttress may further define a proximaledge recess formed in a proximal edge thereof, the proximal edge recesslongitudinally bisecting the proximal edge. A distal edge of the bodyportion of the surgical buttress may be arcuate. A distal edge of thebody portion of the surgical buttress may have a transverse widthdimension less than that of the rest of the body portion. The headportion may have a substantially rectangular shape.

The surgical buttress may be fabricated from a biocompatible andbioabsorbable material.

According to still another aspect of the present disclosure, a surgicalbuttress is provided for use with a surgical stapling apparatus having acartridge assembly of any number of lengths and an anvil assembly of anynumber of lengths corresponding to the lengths of the cartridgeassembly, wherein each of the cartridge assembly and anvil assemblydefines respective juxtaposed tissue contacting surfaces, and whereinthe cartridge assembly includes a plurality of staples stored in stapleslots thereof for formation against staple formation pockets of theanvil assembly. The surgical buttress includes a body portion configuredand dimensioned to overlie all of the staple slots of the cartridgeassembly for any length cartridge assembly, and/or overlie all of thestaple formation pockets of the anvil assembly for any length anvilassembly. The surgical buttress further includes a neck portionextending from the body portion; and a head portion connected to theneck portion and opposite a distal end of the body portion, wherein thebody portion defines at least one pair of opposing proximal recesses,each of the at least one pair of opposing proximal recesses is formed onan opposing lateral side of the body portion near a proximal edge of thebody portion.

According to yet another aspect of the present disclosure a surgicalbuttress for use in a surgical stapling apparatus is provided andincludes an elongate rectangular body portion defining a width; a neckportion integrally formed with and extending from a distal end of thebody portion, the neck portion defining a width; a head portionintegrally formed with and connected to a distal end of the neckportion, the head portion defining a width; and a tail portionintegrally formed with and extending from a proximal end of the bodyportion, the tail portion defining a width. The width of the tailportion is less than the width of the body portion, and the surgicalbuttress is formed from a material having filaments.

In certain embodiments, the width of the neck portion is less than thewidth of the body portion, or the width of the neck portion is less thanthe width of the tail portion, or the width of the neck portion is morethan one-half the width of the body portion.

A length of the head portion may be greater than a length of the tailportion. A length of the head portion may be greater than a length ofthe neck portion.

The tail portion can define at least one pair of opposing proximalrecesses, each of the at least one pair of opposing proximal recesses isformed on an opposing lateral side of the tail portion.

The body portion can further define a pair of opposing distal recesses,each of the pair of opposing distal recesses is formed on an opposinglateral side of the body portion near a distal edge of the body portion.

The tail portion of the surgical buttress can define a proximal edgerecess formed in a proximal edge thereof, wherein the proximal edgerecess longitudinally bisects the proximal edge.

The surgical buttress is desirably fabricated from a biocompatible andbioabsorbable material.

The surgical buttress can be fabricated from a material selected fromthe group consisting of polyglycolic acid, glycolide trimethylenecarbonate, polyglycolic acid trimethylene carbonate, and blends thereof.The surgical buttress can be formed as a non-woven material.

According to a further aspect of the present disclosure, a surgicalbuttress is provided for use with a surgical stapling apparatus having acartridge assembly of any number of lengths and an anvil assembly of anynumber of lengths corresponding to the lengths of the cartridgeassembly, wherein each of the cartridge assembly and anvil assemblydefines respective juxtaposed tissue contacting surfaces, and whereinthe cartridge assembly includes a plurality of staples stored in stapleslots thereof for formation against staple formation pockets of theanvil assembly. The surgical buttress includes an elongate rectangularbody portion defining a length and a width; a neck portion integrallyformed with and extending from a distal end of the body portion, theneck portion defining a length and a width; a head portion integrallyformed with and connected to a distal end of the neck portion, the headportion defining a length and a width; and a tail portion integrallyformed with and extending from a proximal end of the body portion, thetail portion defining a length and a width. The width of the tailportion is less than the width of the body portion. The body portion andthe tail portion are configured and dimensioned to overlie all of thestaple slots of the cartridge assembly for any length cartridgeassembly, and/or overlie all of the staple formation pockets of theanvil assembly for any length anvil assembly.

The width of the neck portion may be less than the width of the bodyportion. The width of the neck portion may be less than the width of thetail portion. The width of the neck portion may be more than one-halfthe width of the body portion.

The length of the head portion may be greater than the length of thetail portion. The length of the head portion may be greater than thelength of the neck portion.

The tail portion may define at least one pair of opposing proximalrecesses. Each of the at least one pair of opposing proximal recessesmay be formed on an opposing lateral side of the tail portion.

The body portion may further define a pair of opposing distal recesses.Each of the pair of opposing distal recesses may be formed on anopposing lateral side of the body portion near a distal edge of the bodyportion.

The tail portion of the surgical buttress may define a proximal edgerecess formed in a proximal edge thereof. The proximal edge recess maylongitudinally bisect the proximal edge.

The surgical buttress may be fabricated from a biocompatible andbioabsorbable material. The surgical buttress may be fabricated from amaterial selected from the group consisting of polyglycolic acid,glycolide trimethylene carbonate, polyglycolic acid trimethylenecarbonate, and blends thereof. The surgical buttress can be made as anon-woven material.

According to another aspect of the present disclosure, a surgicalbuttress for use in a surgical stapling apparatus is provided. Thesurgical buttress includes an elongate rectangular body portion defininga width; a nose portion integrally formed with and extending from adistal end of the body portion, the nose portion defining a width thatis less than the width of the body portion; a neck portion integrallyformed with and extending from a distal end of the body portion, theneck portion defining a width; a head portion integrally formed with andconnected to a distal end of the neck portion, the head portion defininga width; and a tail portion integrally formed with and extending from aproximal end of the body portion, the tail portion defining a width thatis less than the width of the body portion. The surgical buttress isformed from a material having filaments.

The width of the neck portion may be less than the width of the noseportion. The width of the neck portion may be less than the width of thetail portion. The width of the neck portion may be more than one-halfthe width of the body portion.

The tail portion may define at least one pair of opposing proximalrecesses, each of the at least one pair of opposing proximal recesses isformed in an opposing lateral side of the tail portion.

The at least one pair of opposing proximal recesses may include a firstpair of opposing proximal recesses; and a second pair of opposingproximal recesses, wherein the first pair of opposing proximal recessesis disposed proximal of the second pair of opposing proximal recesses.

Each of the second pair of opposing proximal recesses may extend towardsa longitudinal axis of the buttress a greater amount than each of thefirst pair of opposing proximal recesses.

A side edge of the tail portion, disposed between the first pair ofopposing proximal recesses and the pair of opposing proximal recesses,may taper towards a longitudinal axis of the buttress from a proximalend to a distal end.

Each of the first pair of opposing proximal recesses and each of thesecond pair of opposing proximal recesses may have a v-shaped profile. Adistal edge of each of the first pair of opposing proximal recesses andeach of the second pair of opposing proximal recesses may be orientedorthogonal to a longitudinal axis of the buttress.

The body portion may further define a pair of opposing distal recesses.Each of the pair of opposing distal recesses may be formed in opposinglateral sides of the nose portion.

The tail portion of the surgical buttress may define a proximal edgerecess formed in a proximal edge thereof, wherein the proximal edgerecess may longitudinally bisect the proximal edge.

The surgical buttress may be fabricated from a biocompatible andbioabsorbable material. The surgical buttress may be fabricated from amaterial selected from the group consisting of polyglycolic acid,glycolide trimethylene carbonate, polyglycolic acid trimethylenecarbonate, and blends thereof. The surgical buttress may be formed as anon-woven material.

According to still another aspect of the present disclosure, a surgicalbuttress for use with a surgical stapling apparatus is provided. Thesurgical stapling apparatus includes a cartridge assembly of any numberof lengths and an anvil assembly of any number of lengths correspondingto the lengths of the cartridge assembly, wherein each of the cartridgeassembly and anvil assembly defines respective juxtaposed tissuecontacting surfaces, and wherein the cartridge assembly includes aplurality of staples stored in staple slots thereof for formationagainst staple formation pockets of the anvil assembly.

The surgical buttress includes an elongate rectangular body portiondefining a width; a nose portion integrally formed with and extendingfrom a distal end of the body portion, the nose portion defining a widththat is less than the width of the body portion; a neck portionintegrally formed with and extending from a distal end of the bodyportion, the neck portion defining a width; a head portion integrallyformed with and connected to a distal end of the neck portion, the headportion defining a width; and a tail portion integrally formed with andextending from a proximal end of the body portion, the tail portiondefining a width that is less than the width of the body portion.

The body portion and the tail portion are configured and dimensioned toat least one of overlie all of the staple slots of the cartridgeassembly for any length cartridge assembly, and overlie all of thestaple formation pockets of the anvil assembly for any length anvilassembly.

The width of the neck portion may be less than the width of the noseportion.

The tail portion may define at least one pair of opposing proximalrecesses. Each of the at least one pair of opposing proximal recessesmay be formed in an opposing lateral side of the tail portion.

The at least one pair of opposing proximal recesses may include a firstpair of opposing proximal recesses; and a second pair of opposingproximal recesses, wherein the first pair of opposing proximal recessesis disposed proximal of the second pair of opposing proximal recesses.

Each of the second pair of opposing proximal recesses may extend towardsa longitudinal axis of the buttress a greater amount than each of thefirst pair of opposing proximal recesses.

A side edge of the tail portion, disposed between the first pair ofopposing proximal recesses and the pair of opposing proximal recesses,may taper towards a longitudinal axis of the buttress from a proximalend to a distal end.

Each of the first pair of opposing proximal recesses and each of thesecond pair of opposing proximal recesses may have a v-shaped profile. Adistal edge of each of the first pair of opposing proximal recesses andeach of the second pair of opposing proximal recesses may be orientedorthogonal to a longitudinal axis of the buttress.

The body portion may further define a pair of opposing distal recesses.Each of the pair of opposing distal recesses may be formed in opposinglateral sides of the nose portion.

The tail portion of the surgical buttress may define a proximal edgerecess formed in a proximal edge thereof, wherein the proximal edgerecess longitudinally bisects the proximal edge.

The surgical buttress may be formed from a non-woven material.

According to another aspect of the present disclosure, a surgicalbuttress for use in a surgical stapling apparatus is provided. Thesurgical buttress includes an elongate rectangular body portion defininga width and being fabricated from at least one of a biocompatible orbioabsorbable material. The surgical buttress is formed with at leastone marking provided at least one of in or on the body portion.

The at least one marking may be formed as a notch.

The at least one marking may include biocompatible and bioabsorbablematerials.

The at least one marking may include a biocompatible ink.

The at least one marking may be sewn into the surgical buttress.

The body portion may define at least one pair of notch markings onopposing lateral sides of the surgical buttress.

The body portion may include a plurality of markings. The plurality ofmarkings may be formed by physical notches and ink. The plurality ofmarkings may vary in length. The plurality of markings may be evenlyspaced along a length of the surgical buttress.

The surgical buttress may further include a radioactive materialembedded within the body portion. The radioactive material may be atleast one brachytherapy seed.

The body portion may include a plurality of pores or pockets. The atleast one pore may contain a brachytherapy seed.

According to still another aspect of the present disclosure, a surgicalbuttress for use in a surgical stapling apparatus is provided. Thesurgical buttress includes a body portion; and radioactive materialprovided at least one of in or on the body portion.

The body portion may include biocompatible and bioabsorbable materials.

The radioactive material may be at least one brachytherapy seed.

The body portion may include a plurality of pores. At least one pore maycontain a brachytherapy seed.

The surgical buttress may be formed with at least one marking providedat least one of in or on the body portion.

According to still another aspect of the present disclosure, a method ofembedding radioactive material into a surgical buttress is provided. Themethod includes providing a surgical buttress; providing a templatecapable of holding the radioactive material; inserting the radioactivematerial into the template; mating the template to the surgicalbuttress; and embedding the radioactive material into the surgicalbuttress.

The method may further include providing a surgical buttress comprisinga plurality of pores or pockets.

The method may further include providing a template that is capable ofreceiving at least one brachytherapy seed.

The method may further include inserting brachytherapy seeds.

The method may further include embedding the radioactive material intoat least 10% of a surface area of the buttress.

The method may further include embedding the radioactive material into adistal end of the surgical buttress.

The method may further include embedding the radioactive material into aproximal end of the surgical buttress.

The method may further include embedding the radioactive materialuniformly across a surface area of the surgical buttress.

BRIEF DESCRIPTION OF THE DRAWINGS

The present disclosure will be further described with reference to theaccompanying drawings, wherein like reference numerals refer to likeparts in the several views, and wherein:

FIG. 1 is a perspective view of a surgical stapling apparatus accordingto an embodiment of the present disclosure;

FIG. 2 is a top, exploded, perspective view of a distal end of a DLU ofthe surgical stapling apparatus of FIG. 1;

FIG. 3 is a top plan view of a buttress according to an embodiment ofthe present disclosure;

FIG. 4 is a top, perspective view of a cartridge half-section of the DLUof FIG. 2;

FIG. 5 is a perspective view of a cartridge assembly of the DLU of FIG.2;

FIG. 6 is an enlarged perspective view of a distal end of the cartridgeassembly of FIG. 5;

FIG. 7 is an enlarged view of the indicated area of detail of FIG. 5;

FIG. 8 is an enlarged view of the indicated area of detail of FIG. 7;

FIG. 9 is a perspective view of an anvil assembly of the DLU of FIG. 2,illustrating the buttress of FIG. 3 secured thereto;

FIG. 10 is a plan view of the cartridge assembly of the DLU of FIGS. 4-8and the anvil assembly of the DLU of FIG. 9, illustrating the attachmentof the buttress of FIG. 3 at different attachment points of a respectivecartridge assembly and anvil assembly;

FIG. 11 is a top plan view of a buttress according to another embodimentof the present disclosure;

FIG. 12 is a top plan view of a buttress according to yet anotherembodiment of the present disclosure;

FIG. 13 is an enlarged view of the indicated area of detail of FIG. 12;

FIG. 14 is an enlarged view of the indicated area of detail of FIG. 12;

FIG. 15 is a top plan view of a buttress according to another embodimentof the present disclosure;

FIG. 16 is a top plan view of a buttress according to another embodimentof the present disclosure;

FIG. 17 is a top plan view of a buttress according to another embodimentof the present disclosure;

FIG. 18 is a top plan view of a buttress according to another embodimentof the present disclosure;

FIG. 19 is a top plan view of a buttress according to another embodimentof the present disclosure;

FIG. 20 is a cross-sectional view, as taken through 20-20 of FIG. 19;

FIG. 21 is an enlarged view of the indicated area of detail of FIG. 19;

FIG. 22 is a top plan view of a buttress according to another embodimentof the present disclosure;

FIG. 23 is a top plan view of a surgical buttress according to certainembodiments of the present disclosure;

FIG. 24 is a perspective view of a staple cartridge assembly having asurgical buttress attached thereto in accordance with embodiments of thepresent disclosure; and

FIG. 25 is a perspective detail view of one of the pockets of a surgicalbuttress according to certain embodiments of the present disclosure.

DETAILED DESCRIPTION OF EMBODIMENTS

Embodiments of the presently disclosed staple line reinforcement foranvil and cartridge of a loading unit of a surgical stapling apparatuswill now be described in detail with reference to the drawings, in whichlike reference numerals designate identical or corresponding elements ineach of the several views. In the drawings and in the description thatfollows, the term “proximal,” as is traditional, will refer to the endof the stapling apparatus which is closest to the operator, while theterm “distal” will refer to the end of the apparatus which is farthestfrom the operator.

Referring now to FIG. 1, there is disclosed a linear surgical staplingapparatus, generally referred to as 10. In the interest of brevity, thisdisclosure will focus primarily on a buttress utilized in a loading unit100, e.g., a single use loading unit (“SULU”) or a disposable loadingunit (“DLU”). For simplicity, hereinafter, SULU or DLU will be referredto as “DLU,” but it should be understood to include either or both a DLUor SULU. An exemplary example of this type of surgical staplinginstrument is disclosed in U.S. Pat. No. 7,128,253, the entiredisclosure of which is hereby incorporated by reference herein.

Surgical stapling apparatus 10 generally includes a handle assembly 12and an elongate body 14 extending distally from handle assembly 12. ADLU 100 is releasably secured to the distal end of elongate body 14. DLU100 includes a cartridge assembly 200 housing a plurality of surgicalfasteners or staples 223 (see FIG. 2) and an anvil assembly 300 movablysecured in relation to cartridge assembly 200. Handle assembly 12includes a stationary handle member 22, a movable handle member 24, anda barrel portion 26. An articulation lever 30 is mounted on the forwardend of barrel portion 26 adjacent rotatable member 28 to facilitatearticulation of DLU 100. A pair of knobs 32 is movably positioned alongbarrel portion 26. Knobs 32 are advanced distally to approximate orclose cartridge and/or anvil assembly 200, 300, and retracted proximallyto unapproximate or open cartridge and/or anvil assembly 200, 300.Actuation of movable handle member 24 applies lines of staples 223 totissue. In order to properly orient cartridge and anvil assembly 200,300 relative to the tissue to be stapled, surgical stapling apparatus 10is additionally provided with a rotatable member 28 on the forward endof barrel portion 26. Rotation of rotatable member 28 relative to handleassembly 12 rotates elongate body 14 and loading unit 100 relative tohandle assembly 12 so as to properly orient cartridge assembly 200 andanvil assembly 300 relative to the tissue to be stapled.

As seen in FIG. 2, cartridge assembly 200 includes a carrier 210defining an elongated support channel 212. Elongated support channel 212of carrier 210 is dimensioned and configured to selectively receive astaple cartridge 220 therein. Staple cartridge 220 includes retentionslots 222 formed therein for receiving a plurality of fasteners 223 andpushers 226. A plurality of spaced apart longitudinal slots extendthrough staple cartridge 220 to accommodate upstanding cam wedges ofactuation sled 228. A central longitudinal slot 234 is formed in andextends along the length of staple cartridge 220 to facilitate passageof knife blade 156 of drive bar 150 therethrough. During operation ofsurgical stapler 10, actuation sled 228 translates through staplecartridge 220 to advance the cam wedges into sequential contact withpushers 226, to cause pushers 226 to translate vertically withinretention slots 222 and urge staples 223 from slots 222 into stapleforming cavities of anvil plate 310 of anvil assembly 300.

As seen in FIG. 2, cartridge assembly 200 includes a surgical cartridgebuttress 500 operatively secured to an upper surface of staple cartridge220, by sutures “S1, S2,” to overlie at least some of retention slots222 and/or at least a portion of a length of longitudinal slot 234. Afirst suture “S1” is threaded through each of a distal pair of recessesor attachment points 238 and around/over distal portion of cartridgebuttress 500 and, and a second suture “S2” is threaded through each of aproximal pair of recesses or attachment points 236 and around/overproximal portion of cartridge buttress 500. A first end of each suture“S1, S2” may be anchored or fixed in a respective one recesses of theproximal and distal pair of recesses or attachment points 236, 238 whilea second end of each suture “S1, S2” passes transversely acrossrespective distal and proximal portions of cartridge buttress 500 and isanchored or fixed in a respective other recess of the proximal anddistal pair of recesses or attachment points 236, 238. As seen in FIG.10, cartridge assembly 200 defines an axial distance “D1” between thedistal pair of recesses or attachment points 238 and the proximal pairof recesses or attachment points 236.

With reference still to FIG. 2, anvil assembly 300 includes an anvilplate 310 having a plurality of staple deforming pockets/cavities 310 a(see FIG. 9) and a cover plate 320 secured to a top surface of anvilplate 310. Anvil assembly 300 further includes a knife blade 330operatively interposed within the cavity defined between anvil plate 310and cover plate 320.

Anvil plate 310 defines a proximal pair of recesses or attachment points316 formed near a proximal end of anvil plate 310 and disposed, oneeach, on opposed sides of longitudinal slot 314. Anvil plate 310 definesa distal pair of recesses or attachment points 318 formed near a distalend of anvil plate 310 and disposed, one each, on opposed sides oflongitudinal slot 314. At least one recess of each of the proximal pairof recesses or attachment points 316 and the distal pair of recesses orattachment points 318 is in the form of a slot or notch having aconstricting profile so as to frictionally engage and/or pinch a suture“S”. Anvil assembly 300 further includes a surgical anvil buttress 500operatively secured to a lower surface of anvil plate 310, by sutures“S3, S4,” to overlie at least some of anvil pockets 310 a and/or atleast a portion of a length of longitudinal slot 314.

With reference still to FIG. 2, anvil buttress 500 is secured to a lowersurface of anvil plate 310, by anchors “S3, S4”, to overlie at leastsome of the anvil pockets and/or at least a portion of a length oflongitudinal slot 314. In particular, an anchor “S3” is threaded acrossa distal portion of the anvil buttress 500 and each of the correspondingdistal pair of recesses or attachment points 318, and an anchor “S4” isthreaded across a proximal portion of anvil buttress 500 and each of thecorresponding proximal pair of recesses or attachment points 316. Asseen in FIG. 10, anvil assembly 300 defines an axial distance “D2”between the distal pair of recesses or attachment points 318 and theproximal pair of recesses or attachment points 316.

Reference may be made to U.S. patent application Ser. No. 12/342,400,filed on Dec. 23, 2008 (U.S. Pat. No. 8,011,555), the entire content ofwhich is hereby incorporated herein by reference, for a detaileddiscussion of the construction and operation of surgical staplingapparatus 10, cartridge assembly 200 and/or anvil assembly 300.

It is contemplated that the cartridge buttress and/or anvil buttress canbe attached by other means. For example, in any of the embodimentsdisclosed herein, the buttresses can be attached using adhesives,welding, and/or attachment features incorporated in the buttressmaterial.

Buttress 500 for each of cartridge assembly 200 and anvil assembly 300is provided to reinforce and seal staple lines applied to tissue bysurgical stapling apparatus 10. Cartridge assembly 200 and anvilassembly 300 are particularly configured to allow surgical buttresses500 to be localized on inwardly facing surfaces of cartridge assembly200 and anvil assembly 300 in order to facilitate passage of surgicalstapling apparatus 10 into the body of a patient without risk of tearingor wrinkling of the respective buttresses as surgical stapling apparatus10 is inserted into and manipulated within the body of a patient. Thematerial from which the buttress 500 is formed may be bioabsorbable ornon-bioabsorbable. It should be understood that any combination ofnatural, synthetic, bioabsorbable and non-bioabsorbable materials may beused to form the buttress material. The buttress material may be porousor non-porous or a combination of porous and non-porous layers. Thenon-porous buttress material may be utilized to retard or prevent tissueingrowth from surrounding tissues thereby acting as an adhesion barrierand preventing the formation of unwanted scar tissue.

Additional exemplary materials for surgical buttresses 500 for use withthe surgical stapling devices disclosed herein are set forth in commonlyassigned U.S. Pat. Nos. 5,542,594; 5,908,427; 5,964,774; and 6,045,560,and commonly assigned U.S. Application Publication Nos. 2006/0085034,filed on Apr. 20, 2006; and 2006/0135992, filed on Jun. 22, 2006, theentire contents of each of which is hereby incorporated herein byreference.

In an embodiment, surgical buttresses 500 may be fabricated from asuitable biocompatible and bioabsorbable material. Surgical buttresses500 may also be fabricated from a non-absorbent material which does notretain fluid, for example, surgical buttresses 500 may be fabricatedfrom “BIOSYN™” (a synthetic polyester, commercially available from TycoHealthcare Group, LP d/b/a COVIDIEN, North Haven, Conn.), which is madefrom “GLYCOMER 631” (a block copolymer) which is a synthetic polyestercomposed of glycolide, dioxanone and trimethylene carbonate.

One block of the resulting copolymer contains randomly combined unitsderived from p-dioxanone (1,4-dioxan-2-one) and trimethylene carbonate(1,3-dioxan-2-one). A second block of the copolymer contains randomlycombined units derived from glycolide and p-dioxanone. The resultingpolyester is an ABA triblock terpolymer possessing about 60% glycolide,about 14% dioxanone, and about 26% trimethylene carbonate.

Anvil buttress and/or cartridge buttress 500 may be pre-loaded (i.e.,from the manufacturer) onto anvil assembly 300 or cartridge assembly200. Additional or replacement buttresses 500 for anvil assembly 300and/or cartridge assembly 200 may be secured to either anvil assembly300 or cartridge assembly 200 as needed or desired.

In operation, with DLU 100 coupled to a distal end of elongated body 14of surgical stapling apparatus 10, and with anvil and cartridgebuttresses 500 pre-loaded onto anvil assembly 300 and cartridge assembly200, respectively, surgical stapling apparatus 10 is used in accordancewith methods known by those skilled in the art. Once anvil assembly 300and cartridge assembly 200 are clamped onto tissue, surgical staplingapparatus 10 is fired. In firing surgical stapling apparatus 10, drivebar 150 is advanced from a proximal-most position to a distal-mostposition of DLU 100. In so doing, knife blade 156 of drive bar 150enters notch 528 of buttress 500 thereby facilitating the dividing ofbuttress 500 and reducing any incidents of pushing or bunching-up ofbuttress 500 by blade 156. As drive bar 150 begins to travel distally,knife blade 156 substantially simultaneously cuts through a centralsection of the proximal anchors “S2, S4” of anvil assembly 300 andcartridge assembly 200, thereby respectively freeing the proximal endsof anvil and cartridge buttresses 500 therefrom. As knife blade 156 ismoved distally, knife blade 156 slices or cuts longitudinally throughboth anvil buttress 500 and cartridge buttress 500, thereby dividing thebuttresses 500 substantially in half

Additionally, as drive bar 150 approaches the distal-most position,drive bar 150 and/or knife blade 156 engage a suture cutting assembly orsuture release assembly, as described in U.S. patent application Ser.No. 12/342,400, filed on Dec. 23, 2008, the entire content of which ishereby incorporated herein by reference, to thereby sever or releasedistal sutures “S1 or S3” and thus release a distal end of buttress 500.

With reference to FIG. 3, an embodiment of a surgical buttress 500having a uniform profile in accordance with the present disclosure isillustrated. Buttress 500 includes a head portion 510, a body portion520, a neck portion 530 interconnecting head portion 510 and bodyportion 520, and a tail portion 532 extending proximally from bodyportion 520.

Buttress 500 is configured to be detachably secured to any sized anvilassembly 300 and/or cartridge assembly 200, as described above. Bodyportion 520 of buttress 500 defines a pair of opposing distal recesses524 on transverse edges near a distal location 522 thereof. The pair ofopposing distal recesses 524 may be utilized to secure body portion 520to a distal end of anvil assembly 300 and/or cartridge assembly 200,either through a use of suture “S1 or S3” or any other type of fastener,e.g., staple. Distal portion 522 of body portion 520 has a reducedtransverse cross-sectional dimension, e.g., angled, arcuate, so as to besuitable for various types of anvil and cartridge assemblies havingdifferent shapes.

Tail portion 532 of buttress 500 defines two pairs of opposing proximalrecesses 526 a, 526 b formed therein. Each of the pair of proximalrecesses 526 a, 526 b is disposed on a transverse side of tail portion532 near the proximal edge thereof. Such proximal pair of recesses 526a, 526 b serve to detachably secure tail portion 532 of buttress 500 toa proximal end of anvil assembly 300 and/or cartridge assembly 200. Inorder to accommodate various types of profiles, tail portion 532 ofbuttress 500 preferably has been provided with two pairs of opposingrecesses, a first proximal pair of recesses 526 a, and a second proximalpair of recesses 526 b (located distal of the first proximal pair ofrecesses 526 a). Each of the proximal pair of recesses 526 a, 526 b hasa substantially v-shape profile.

In particular, when buttress 500 is to be used with a relatively longeranvil assembly 300 and/or cartridge assembly 200, then a suture “S2 orS4” is extended across tail portion 532 of buttress 500, passed throughthe proximal-most pair of recesses 526 a of buttress 500, and secured torespective recesses 316 of anvil assembly 300 and/or recesses 236 ofcartridge assembly 200. Moreover, when buttress 500 is to be used with arelatively shorter anvil assembly 300 and/or cartridge assembly 200,then a suture “S2 or S4” is extended across tail portion 532 of buttress500, passed through the distal pair 526 b of the proximal pair ofrecesses of buttress 500, and secured to respective recess 316 of anvilassembly 300 and/or recesses 236 of cartridge assembly 200.

According to another aspect of the present disclosure, a single profileor configuration buttress 500 may be used in connection with cartridgeassembly 200 and/or anvil assembly 300. For example, the buttresses 500that are used in connection with cartridge assembly 200 and anvilassembly 300 each may have the same overall length, width, thickness,perimetrical profile and material of construction.

In particular, as seen in FIG. 10, when buttress 500 is used inconnection with cartridge assembly 200, a suture “S1” may extendtransversely across a distal end portion of cartridge assembly 200 andcaptures or is otherwise secured to distal pair of recesses orattachment points 238 of cartridge assembly 200, wherein suture “S1” isin registration with distal recesses 524 of secure a distal end of bodyportion 520 of buttress 500. Additionally, when buttress 500 is used inconnection with cartridge assembly 200, a suture “S2” may extendtransversely across a proximal end portion of cartridge assembly 200 andcaptures or is otherwise secured to each of a proximal pair of recessesor attachment points 236 of cartridge assembly 200, wherein suture “S2”is in registration with the proximal-most pair 526 a of the proximalpair of recesses of tail portion 532 of buttress 500.

With continued reference to FIG. 10, when buttress 500 is used inconnection with anvil assembly 300, a suture “S3” may extendtransversely across a distal end portion of anvil assembly 300 andcaptures or is otherwise secured to distal pair of recesses orattachment points 318 of anvil assembly 300, wherein suture “S3” is inregistration with distal recesses 524 of secure a distal end of bodyportion 520 of buttress 500. Additionally, when buttress 500 is used inconnection with anvil assembly 300, a suture “S4” may extendtransversely across a proximal end portion of anvil assembly 300 andcaptures or is otherwise secured to each of a proximal pair of recessesor attachment points 316 of anvil assembly 300, wherein suture “S4” isin registration with the distal pair 526 b of the proximal pair ofrecesses of tail portion 532 of buttress 500.

Neck portion 530 connects head portion 510 to a distal end of bodyportion 520. Generally, head portion 510 is in a substantiallyrectangular shape which is used as a tab to facilitate placement ofbuttress 500 in position on anvil assembly 300 and/or cartridge assembly200. Following placement of buttress 500 on anvil assembly 300 and/orcartridge assembly 200, head portion 510 and neck portion 530 may betorn or otherwise cut away from body portion 520.

Tail portion 532 of buttress 500 includes a notch 528 at a proximal edgethereof. Notch 528 is substantially centered with respect to thelongitudinal axis. Notch 528 which has a triangular or V-shapeconfiguration may be utilized to provide a lead-in for the knife duringa cutting of buttress 500. Notch 528 has a length “L3a”, as seen in FIG.3.

As seen in FIG. 3, buttress 500 has an overall length “La”. Body portion520 of buttress 500 has a length “L1a”, and tail portion 532 has alength “L2a”. Body portion 520 has a width “W1a” and tail portion 532has a width “W2a” which is less that width “W1a” of body portion 520,wherein a shoulder 534 is defined between a side edge of body portion520 and a side edge of tail portion 532. It is contemplated that ashoulder 534 is provided or defined along each opposed side edge ofbuttress 500.

With continued reference to FIG. 3, neck portion 530 of buttress 500 hasa length “L4a”, and head portion 510 has a length “L5a”. Neck portion530 of buttress 500 has a width “W3a” which is less that width “W1a” ofbody portion 520 and less than width “W2a” of tail portion 532. Also,head portion 510 has a width “W4a” which is substantially equal to width“W1a” of body portion 520.

The uniform profile of buttress 500 which simultaneously satisfies therequirements of one or more different assemblies offers advantages ofsimplifying the assembly process, minimizing the total number of uniquecomponents, and reducing assembly costs associated therewith.

Moreover, buttress 500 may be used on or in connection with cartridgeassembly 200 and/or anvil assembly 300. In this manner, a single profilebuttress 500 is produced and used for cartridge assembly 200 and/oranvil assembly 300. As such, the manufacturing and storage costs forbuttresses 500 may be reduced.

As mentioned above, DLU 100 includes an anvil surgical buttress 500 anda cartridge surgical buttress 500 pre-loaded onto anvil assembly 300 andcartridge assembly 200. An exemplary method of loading anvil assembly300 and/or cartridge assembly 200 with a buttress 500 will now bedescribed.

During the manufacturing and/or assembly process of DLU 100, loading ofanvil assembly 300 and/or cartridge assembly 200 with buttress 500includes the step of placing a buttress 500 atop a tissue contactingsurface of anvil assembly 300 and/or cartridge assembly 200 such thatnotch 528 of buttress is disposed near a proximal end of anvil assembly300 and/or cartridge assembly 200 and head portion 510 of buttress 500extends from a distal end of anvil assembly 300 and/or cartridgeassembly 200. With buttress 500 so positioned against anvil assembly 300and/or cartridge assembly 200, proximal sutures “S2” and/or “S4” arepulled down. Tension is then applied to buttress 500, in a distaldirection, by pulling on head portion 510. Distal sutures “S1” and/or“S3” are then pulled down. At this time, all the sutures “S1-S4” arecinched in the respective attachment points 316, 318, 236, 238 of anvilassembly 300 and/or cartridge assembly 200. Following cinching ofsutures “S1-S4,” head portion 510 of buttress 500 may be released. Next,DLU 100 may be removed from a nesting and head portion 510 and neckportion 530 of buttress 500 may be removed or severed from body portion520.

While the above-described embodiments surgical staplers incorporatingthe use of movable knife blades to sever and release surgical buttressesfrom the tissue contacting surfaces of the anvil assembly and thecartridge assembly have been shown and described in relation toendoscopic surgical staplers, it is envisioned and within the scope ofthe present disclosure that any of the embodiments disclosed herein maybe incorporated into any type of surgical stapler, including and notlimited to open surgical staplers, such as, for example, linear surgicalstaplers, circular staplers, and transverse surgical staplers.

Moreover, while only distal and proximal sutures have been shown anddescribed as securing buttress 500 to anvil assembly 300 and/orcartridge assembly 300, it is contemplated that, in any of theembodiments disclosed herein, any number of transverse sutures may beprovided along a length of the anvil assembly and/or cartridge assemblyto aid with the securement of buttress 500 along a length thereof.

Any of the surgical buttresses disclosed herein may be comprised of theGLYCOMER 631 a block copolymer, or other polymers discussed above, as afilm, non-woven, mesh or other type of material, and may also be made asa film, non-woven, mesh or other type of material, from poly-L-lactide(PLL), or Polycaprolactam (Nylon-6), or polyglycolic acid (PGA) each ofwhich are homopolymers, or from glycolide trimethylene carbonate(Gly-TMC), which is a copolymer, PLL and Gly-TMC both beingbio-degradable polyesters polymerized through a ring opening reaction.The non-woven material can be made utilizing a melt blown or spun bondprocess, or other known process. Non-woven materials and polymers aredisclosed in U.S. patent application Ser. No. 13/293,215, entitledHydrophilic Medical Devices, filed Nov. 10, 2011 (U.S. PatentPublication No. 2013-0123816), the disclosure of which is herebyincorporated by reference in its entirety. In certain embodiments,non-woven, felted, or other relatively supple materials having filamentsare preferred.

Turning now to FIG. 11, a surgical buttress having a uniform profile, inaccordance with another embodiment of the present disclosure, isgenerally illustrated as 600. Buttress 600 includes a head portion 610,a body portion 620, a neck portion 630 interconnecting head portion 610and body portion 620, and a tail portion 632 extending proximally frombody portion 620.

Buttress 600, similar to buttress 500, is configured to be detachablysecured to any sized anvil assembly 300 and/or cartridge assembly 200,as described above. Body portion 620 of buttress 600 defines a pair ofopposing distal recesses 624 formed in opposed transverse side edgesnear a distal location 622 thereof.

In order to accommodate various types of profiles, tail portion 632 ofbuttress 600 includes two pairs of opposing recesses, a first proximalpair of recesses 626 a, and a second proximal pair of recesses 626 b(located distal of the first proximal pair of recesses 626 a). Each ofthe proximal pair of recesses 626 a, 626 b has a substantially v-shapeprofile. Each of the proximal pair of recesses 626 a, 626 b is shalloweras compared to the proximal pair of recesses 526 a, 526 b of tailportion 532 of buttress 500.

Neck portion 630 connects head portion 610 to a distal end of bodyportion 620. Generally, head portion 610 is in a substantiallyrectangular shape which is used as a tab to facilitate placement ofbuttress 600 in position on anvil assembly 300 and/or cartridge assembly200. Following placement of buttress 600 on anvil assembly 300 and/orcartridge assembly 200, under at least certain circumstances, headportion 610 and neck portion 630 may be torn, damaged, or otherwise cutaway from body portion 620.

Tail portion 632 of buttress 600 includes a notch 628 at a proximal edgethereof. Notch 628 is substantially centered with respect to thelongitudinal axis. Notch 628 which has a U shaped configuration, atriangular, or V-shape configuration, and may be utilized to provide alead-in for the knife during a cutting of buttress 600. Notch 628 has alength “L3b”, as seen in FIG. 11. Length “L3b” of notch 628 of buttress600 is greater than length “L3a” of notch 528 of buttress 500, and thenotch 628 ends just before the first recesses 626 a.

As seen in FIG. 11, buttress 600 has an overall length “Lb”, which isgreater than the overall length “La” of buttress 500. Body portion 620of buttress 600 has a length “L1b”, and tail portion 632 has a length“L2b”. Body portion 620 has a width “W1b” and tail portion 632 has awidth “W2b” which is less that width “W1b” of body portion 620, whereina shoulder 634 is defined between a side edge of body portion 620 and aside edge of tail portion 632. It is contemplated that a shoulder 634 isprovided or defined along each opposed side edge of buttress 600.

With reference to FIGS. 3 and 11, it is contemplated that body portion620 of buttress 600 has a length “L1b” which is greater than length“L1a” of body portion 520 of buttress 500. Additionally, it iscontemplated that tail portion 632 of buttress 600 has a length “L2b”which is greater than length “L2a” of tail portion 532 of buttress 500.

With reference back to FIG. 11, neck portion 630 of buttress 600 has alength “L4b”, and head portion 610 has a length “L5b”. Neck portion 630of buttress 600 has a width “W3b” which is less that width “W1b” of bodyportion 620, and which is substantially equal to width “W2b” of tailportion 632. Also, head portion 610 has a width “W4b” which issubstantially equal to width “W1b” of body portion 620.

With reference to FIGS. 3 and 11, it is contemplated that neck portion630 of buttress 600 has a width “W3b” which is greater than width “W3a”of neck portion 530 of buttress 500. Additionally, it is contemplatedthat head portion 610 of buttress 600 has a length “L5b” which isgreater than length “L5a” of head portion 510 of buttress 500.

Turning now to FIGS. 12-14, a surgical buttress having a uniformprofile, in accordance with yet another embodiment of the presentdisclosure, is generally illustrated as 700. Buttress 700 includes ahead portion 710, a body portion 720, a nose portion 736 extendingdistally from body portion 720, a neck portion 730 interconnecting noseportion 736 and body portion 720, and a tail portion 732 extendingproximally from body portion 720.

As illustrated in FIGS. 12-14, buttress 700 has an overall length “Lc”,which is greater than the overall length “La” of buttress 500. Bodyportion 720 of buttress 700 has a length “L1c”, tail portion 732 has alength “L2c”, and nose portion 734 has a length “L6c”. Body portion 720has a width “W1c”, tail portion 732 has a width “W2c” which is less thatwidth “W1c” of body portion 720, wherein a shoulder is defined between aside edge of body portion 720 and a side edge of tail portion 732, andnose portion 734 has a width “W5c” which is less that width “W1c” ofbody portion 720, wherein a shoulder is defined between a side edge ofbody portion 720 and a side edge of nose portion 734. It is contemplatedthat shoulders are provided or defined along each opposed side edge ofbuttress 700.

With reference to FIGS. 3, 12 and 13, it is contemplated that bodyportion 720 of buttress 700 has a length “L1c” which is greater thanlength “L1a” of body portion 520 of buttress 500. Additionally, it iscontemplated that tail portion 732 of buttress 700 has a length “L2c”which is greater than length “L2a” of tail portion 532 of buttress 500.

With reference back to FIGS. 12 and 14, nose portion 736 of buttress 700has a length “L6c.”

Neck portion 730 of buttress 700 has a length “L4c”, and head portion710 of buttress 700 has a length “L5c”. Neck portion 730 of buttress 700has a width “W3c” which is less that width “W5c” of nose portion 736.Head portion 710 of buttress 700 has a width “W4c” which issubstantially equal to width “W5c” of nose portion 736.

With reference to FIGS. 12 and 13, it is contemplated that neck portion730 of buttress 700 has a width “W3c” which is greater than width “W3a”of neck portion 530 of buttress 500. Additionally, it is contemplatedthat head portion 710 of buttress 700 has a length “L5c” which issubstantially equal to length “L5a” of head portion 510 of buttress 500.

Buttress 700, similar to buttress 600, is configured to be detachablysecured to any sized anvil assembly 300 and/or cartridge assembly 200,as described above. Buttress 700 defines a pair of opposing distalrecesses 724 formed in opposed transverse side edges of nose portion736. Each distal recess 724 has a substantially v-shaped profile.Specifically, each distal recess 724 includes a distal portion that isoriented orthogonal to a longitudinal axis of buttress 700, and aproximal portion that is oriented transverse to the longitudinal axis ofbuttress 700. In an embodiment, the proximal portion of each distalrecess 724 may be oriented at about a 63° angle relative to thelongitudinal axis of buttress 700.

In order to accommodate various types of profiles, tail portion 732 ofbuttress 700 includes two pairs of opposing recesses, a first proximalpair of recesses 726 a, and a second proximal pair of recesses 726 b(located distal of the first proximal pair of recesses 726 a). Each ofthe proximal pair of recesses 726 a, 726 b has a substantially v-shapedprofile.

Specifically, each recess of the first proximal pair of recesses 726 aand each recess of the second proximal pair of recesses 726 b includes adistal portion that is oriented orthogonal to a longitudinal axis ofbuttress 700, and a proximal portion that is oriented transverse to thelongitudinal axis of buttress 700. In an embodiment, the proximalportion of each of the first and second proximal pair of recesses 726 a,726 b may be oriented at about a 60° angle relative to the longitudinalaxis of buttress 700.

As best illustrated in FIG. 13, the segment or portion of side edges oftail portion 732, located between the first proximal pair of recesses726 a and the second proximal pair of recesses 726 b, is angled ortapers towards the longitudinal axis of buttress 700, from a proximalend to a distal end thereof.

With reference to FIGS. 12 and 13, neck portion 730 connects headportion 710 to a distal end of nose portion 734. Generally, head portion710 is in a substantially rectangular shape which is used as a tab tofacilitate placement of buttress 700 in position on anvil assembly 300and/or cartridge assembly 200. Following placement of buttress 700 onanvil assembly 700 and/or cartridge assembly 200, under at least certaincircumstances, head portion 710 and neck portion 730 may be torn,damaged, or otherwise cut away from nose portion 734.

Tail portion 732 of buttress 700 includes a notch 728 at a proximal edgethereof. Notch 728 is substantially centered with respect to thelongitudinal axis of buttress 700. Notch 728 my have a U shapedconfiguration, a triangular, or V-shape configuration, and may beutilized to provide a lead-in for the knife during a cutting of buttress700. Notch 728 has a length “L3c”, as seen in FIGS. 12 and 13. Length“L3c” of notch 728 of buttress 700 is greater than length “L3a” of notch528 of buttress 500, and the notch 728 ends just before the firstrecesses 726 a.

With reference to FIG. 15, a surgical buttress 800 a having a uniformprofile in accordance with another embodiment of the present disclosureis illustrated. Buttress 800 a, similar to buttress 600, is configuredto be detachably secured to any sized anvil assembly 300 and/orcartridge assembly 200, as described above.

Surgical buttress 800 a includes a body portion 820 a having at leastone marking 824 disposed therein and/or thereon. Marking(s) 824 includeindicia, e.g. patterns, shapes, alphanumeric labeling, etc., to indicatea length of the staple line. As illustrated in FIG. 15, marking(s) 824may be formed of biocompatible or bioabsorbable ink, and/or radiopaqueink or material, that is imprinted longitudinally along the body portion820 a as lines 824 a and/or numerals 828 a. Line marking(s) 824 a may beoriented orthogonal to the longitudinal axis of the buttress 800 a andmay extend across an entire width of the body portion 820 a.Additionally, it is contemplated that a plurality of line markings 824 amay be equidistant to one another defining a distance “M2a” betweenadjacent line markings 824 a. It is contemplated that the markings canbe formed using radiopaque inks and/or materials.

Referring now to FIG. 16, a surgical buttress 800 b having a uniformprofile in accordance with another embodiment of the present disclosureis illustrated. Buttress 800 b, similar to buttress 800 a, is configuredto be detachably secured to any sized anvil assembly 300 and/orcartridge assembly 200, as described above.

Surgical buttress 800 b includes a body portion 820 b having at leastone marking 824′ disposed therein. Marking(s) 824′ include indiciaand/or recesses, score lines, embossing, etc., to indicate a length ofthe staple line. As illustrated in FIG. 16, marking(s) 824′ may beformed of biocompatible or bioabsorbable ink, and/or radiopaque ink, asnumerals 828 b and as a series of recesses or notches 824 b extendinglongitudinally along the body portion 820 b. Recesses 824 b may beV-shaped and disposed, one each, on opposing sides of the body portion820 b. Additionally, it is contemplated that a plurality of recesses 824b may be equidistant to one another defining a distance “M3a” betweenadjacent recesses 824 b.

It is contemplated that, in any of the embodiments disclosed herein,markings such as those disclosed herein can be pre-incorporated in asurgical buttress to identify tissue or specimen structures aftersurgical resection with a surgical instrument or surgical stapler. Themarkings can be applied during the manufacturing process by methodsincluding thermal or laser processes, printing, sewing, stamping,cutting, dyeing, etc. Alternatively, the markings can be placed byforming notches or holes. Any inks or sewn structures must bebiocompatible materials and would desirably be bioabsorbable. It iscontemplated that the markings can be used to identify the margins ofdiseased tissue. For example, the buttress material will be present onthe tissue remnant and the specimen removed. A pathologist cancommunicate to a surgeon the location of any tissue having anomalieswith reference to the markings

With reference to FIG. 17, a surgical buttress 800 c having a uniformprofile in accordance with another embodiment of the present disclosureis illustrated. Buttress 800 c, similar to buttress 800 a, is configuredto be detachably secured to any sized anvil assembly 300 and/orcartridge assembly 200, as described above. The buttress 800 c can beprovided separately and attached to a surgical instrument by the user,or it can be pre-loaded on an instrument, as discussed above.

Surgical buttress 800 c includes a body portion 820 c having at leastone marking 824″ disposed therein and/or thereon. Marking(s) 824″include indicia, e.g. patterns, shapes, alphanumeric labeling, etc., toindicate a length of the staple line. As illustrated in FIG. 17,marking(s) 824″ may be formed of biocompatible or bioabsorbable ink thatis imprinted longitudinally along the body portion 820 c as lines 824 cand/or numerals 828 c. Line marking(s) 824 c may be oriented orthogonalto the longitudinal axis of buttress 800 c and may extend across anentire width of the body portion 820 c. Additionally, it is contemplatedthat a plurality of line markings 824 c may not be equidistant to oneanother defining, for example, a distance “M4a” between a first linemarking 824 c ₁ and a second line marking 824 c ₂ and a distance “M4b”between a second line marking 824 c ₂ and an adjacent line marking orthird line marking 824 c ₃.

Referring now to FIG. 18, a surgical buttress 800 e having a uniformprofile in accordance with another embodiment of the present disclosureis illustrated. Buttress 800 d, similar to buttress 800 a, is configuredto be detachably secured to any sized anvil assembly 300 and/orcartridge assembly 200, as described above.

Surgical buttress 800 e includes a body portion 820 e having at leastone marking 824′ disposed therein. Marking(s) 824′ include indiciaand/or recesses, score lines, embossing, etc., to indicate a length ofthe staple line. As illustrated in FIG. 18, marking(s) 824′ may beformed of biocompatible or bioabsorbable ink that is imprintedlongitudinally along the body portion 820 d as lines 824 d and/ornumerals 828 d. The markings(s) 824″ may further include a series ofrecesses 826 e extending longitudinally along the body portion 820 d.Recesses 826 d may be V-shaped and disposed, one each, on opposing sidesof the body portion 820 d. Additionally, it is contemplated that aplurality of recesses 826 d and line markings 824 d are positioned in analternating pattern and may be equidistant to one another defining adistance “M5a” between the line marking 824 d and adjacent recess 826 d.

Now turning to FIG. 19, a surgical buttress 900 having a uniform profilein accordance with another embodiment of the present disclosure isillustrated. Buttress 900, similar to buttress 800 a, is configured tobe detachably secured to any sized anvil assembly 300 and/or cartridgeassembly 200, as described above.

Surgical buttress 900 includes a body portion 920 having at least onemarking 924 disposed therein and/or thereon. Marking(s) 924 includeindicia, e.g. patterns, shapes, alphanumeric labeling, etc., to indicatea length of the staple line. As illustrated in FIG. 20, marking(s) 924may be formed of biocompatible or bioabsorbable ink that is imprintedlongitudinally along the body portion 920 as lines 924 and/or numerals928. Line marking(s) 928 may be oriented orthogonal to the longitudinalaxis of buttress 900 and may vary in length thereby extending across apercentage or an entire width of the body portion 920. Additionally, itis contemplated that a plurality of line markings 924 may be equidistantto one another defining a distance “M6a” between adjacent line markings924. It is contemplated that any of the embodiments disclosed herein caninclude the markings disclosed.

In any of the embodiments disclosed herein, the surgical buttress canfurther include at least one source of radioactive material disposed inor on the body portion of the buttress.

The radioactive material 940 is disposed in and/or on the body portion920 and includes encapsulated radioactive isotopes. It is envisionedthat the radioactive material 940 is formed as brachytherapy seeds andthe seeds may be embedded into the body portion 920 of the surgicalbuttress 900 prior to loading the surgical buttress 900 into the anvilassembly 300 and/or cartridge assembly 200. Radioactive material 940 maytake the form of individual radioactive seeds/capsules or radioactiveseeds/capsules incorporated into a biocompatible or bioabsorbable threador the like.

As illustrated in FIG. 20, the radioactive material 940 may be scatteredthroughout the body portion 920 at varying depths. Alternatively, theradioactive material 940 may be disposed evenly throughout the bodyportion 920. Additionally, the radioactive material 940 may be depositedon or into a section of the body portion 920. Further, radioactivematerial 940 may be disposed solely along each lateral side edge of bodyportion 920 of surgical buttress 900. In this manner, radioactivematerial 940 is not affected, impacted or disturbed by any staples beingfired by the stapling apparatus or by the knife blade that is advancedduring a firing of the stapling apparatus. It is contemplated that anyof the embodiments disclosed herein can include the radioactivematerial.

It is contemplated that the process of embedding the radioactivematerial 940 into the surgical buttress 900 includes inserting theradioactive material 940 into a template (not shown) capable of holdingthe radioactive material 940, then mating or abutting the template withthe surgical buttress 900 and embedding the radioactive material 940into the body portion 920 of the surgical buttress 900.

As illustrated in FIG. 21, the radioactive material 940 may be in theform of a seed embedded into a pore 950 or pocket disposed in thesurgical buttress 900. For example, the pore 950 may be formed whilemating the template with the surgical buttress 900 prior to embeddingthe radioactive material 940 therein.

Now turning to FIG. 22, a surgical buttress 1000 having a uniformprofile in accordance with another embodiment of the present disclosureis illustrated. Surgical buttress 1000 includes a body portion 1020 thatis annular in shape having at least one marking 1024 disposed thereinand/or thereon. Marking(s) 1024 include indicia, e.g. patterns, shapes,alphanumeric labeling, etc., to indicate an arc length of the stapleline. As illustrated in FIG. 23, marking(s) 1024 may be formed ofbiocompatible or bioabsorbable ink, and/or radiopaque material, that isimprinted radially about the body portion 1020 as lines 1024 and/ornumerals 1028. Line marking(s) 1028 may be oriented radial to a centralaxis of body portion 1020 and may extend across an entire radius of thebody portion 1020. Additionally, it is contemplated that a plurality ofline markings 1024 may be radially disposed, equidistant to one another,defining an arc length “M7a” between adjacent line markings 1024.

With reference still to FIG. 22, surgical buttress 1000 further includesat least one radioactive material 1040 disposed in and/or on the bodyportion 1020. It is envisioned that the radioactive material 1040 isformed as brachytherapy seed(s) and the seed(s) may be embedded into thebody portion 1020 of the surgical buttress 1000 prior to loading thesurgical buttress 1000 into a surgical stapling device.

Additionally, the radioactive material 1040 may be deposited on or intoa section of the body portion 1020. It is contemplated that the processof embedding the radioactive material 1040 into the surgical buttress1000 includes inserting the radioactive material 1040 into a template(not shown) capable of holding the radioactive material 1040, thenmating the template with the surgical buttress 1000 and embedding theradioactive material 1040 into the body portion 1020 of the surgicalbuttress 1000. The radioactive material 1040 may be embedded into a poreor pocket (not shown) disposed in the surgical buttress 1000. Forexample, the pore or pocket (not shown) may be created while mating thetemplate with the surgical buttress 1000 prior to embedding theradioactive material 1040.

In any of the embodiments disclosed herein, the buttresses may beincorporated into, or configured for use with, devices that are part ofa powered surgical system or robotic surgical system.

It is also contemplated that, for any of the buttresses disclosedherein, the buttress can have pre-formed (e.g., by the manufacturer)pockets or pores configured and arranged for the receipt of theradioactive material discussed above. It is contemplated thatbrachytherapy seeds can be separately packaged and provided, with orwithout a template, and that the user can apply the seeds to thebuttress or buttresses. For example, the user (such as a surgeon oroperating room nurse) can place a seed into one or more of the pocketsor pores discussed above. It is contemplated that the pockets or poresare pre-formed in the buttress, whether pre-loaded on a surgicalinstrument or not. In certain embodiments, the pockets or pores aredisposed on the lateral edges of the surgical buttress as shown in FIGS.23-25. The buttress may be configured with lateral wings that extendbeyond the sides of the surgical stapler jaws. In any of the embodimentsdisclosed herein, the buttress material may be porous and configured toencourage tissue ingrowth.

FIG. 23 shows a surgical buttress 1010 having a series of markings,which may be formed as discussed above. The markings 1020 a can have apattern 1020 that would aid a surgeon, operating room nurse, and/orpathologist in identifying the location of certain tissue that wasexcised from the body. For example, the pattern shown has alternatingshorter and longer lines, however, other patterns may be used. Thebuttress 101 has a central, proximally located notch 1022 at thelocation where a knife of a surgical stapler will cut through tissue, toaid the advancement of the knife. Such notch 1022 may be triangular oroblong in shape.

The surgical buttress 101 can have wings or lateral edges 1024, alongthe long sides of the buttress, which extend beyond the sides of thestaple cartridge 1030. Such wings 1024 can include or incorporatepockets or pores for the receipt of radioactive material. For example,brachytherapy seeds, which may be configured as discussed herein, can beinserted in the pockets or pores 1025. This can be done by themanufacturer, or by the surgeon or operating room nurse whether or notthe staple cartridge assembly has a pre-loaded buttress. A tool 1040,which can be a tweezer or a specially designed device, can be used tosafely insert the seed or seeds 1026 into the pockets or pores 1025. Oneadvantage of having a plurality of pockets or pores along the length ofthe side edges of the buttress 1010 is that the surgeon or operatingroom nurse can insert seeds 1026 in some or all of the pockets, on oneor more sides of the buttress, or may do so in some advantageouspattern.

Although a linear surgical stapling cartridge and buttress is shown,other types are contemplated. For example, a buttress for a circularstapler could have an outer circular edge with a wing or flange thatincorporates or includes pockets or pores.

It is contemplated that the radioactive material can come in otherforms. For example, the wings, or flanges, can be provided, and a sutureor strand having radioactive material inside or on it, can be threadedthrough the wing or flange. It is contemplated that the radioactivematerial can be provided as brachytherapy seeds that are installed inpockets that are adhesively attached to the wing or flange of thesurgical buttress. It is contemplated that the radioactive material isattached to a surgical buttress at locations other than the lateralsides or outer circular edge.

It is contemplated that a surgical buttress having markings as discussedherein may or may not include the radioactive material or means forattaching radioactive material. It is contemplated that a surgicalbuttress having the radioactive material or means for attachingradioactive material as discussed herein may or may not includemarkings.

The present disclosure also includes a surgical kit having a surgicalstapling instrument, at least one surgical buttress, and a separatepackage of encapsulated radioactive material. The surgical staplinginstrument can be a circular stapler. The surgical stapling instrumentcan be a surgical stapling loading unit. The loading unit can be astaple cartridge assembly. The at least one surgical buttress may bepre-loaded onto the surgical stapling instrument. The at least onesurgical buttress can include pockets. The at least one surgicalbuttress can be formed with lateral sides or edges and can includepockets on the lateral sides or edges of the at least one buttress. Thelateral sides or edges can include wings that are configured to extendbeyond the edges of the cartridge and/or surgical stapling instrumentjaws. The encapsulated radioactive material may include radioactiveisotopes, such as iodine or cesium isotopes, and may be brachytherapyseeds. The package can include shielding (e.g., for the isotopes). Thepackage can include a template and the isotopes can be attached to thetemplate.

It will be understood that various modifications may be made to theembodiments disclosed herein. For example, the stapling apparatus neednot apply staples but rather may apply two part fasteners as is known inthe art. Further, the length of the linear row of staples or fastenersmay be modified to meet the requirements of a particular surgicalprocedure. Thus, the length of a single stroke of the actuation shaftand/or the length of the linear row of staples and/or fasteners within adisposable loading unit may be varied accordingly. Therefore, the abovedescription should not be construed as limiting, but merely asexemplifications of preferred embodiments. Those skilled in the art willenvision other modifications within the scope and spirit of the claimsappended thereto.

What is claimed is:
 1. A surgical buttress for use in a surgicalstapling apparatus, the surgical buttress, comprising a body portionhaving lateral sides defining pockets.
 2. The surgical buttressaccording to claim 1, wherein the body portion includes biocompatibleand bioabsorbable materials.
 3. The surgical buttress according to claim1, further comprising a radioactive material disposed in at least someof the pockets.
 4. The surgical buttress according to claim 1, whereinat least some of the pockets of the body portion contain a brachytherapyseed.
 5. The surgical buttress according to claim 4, wherein thebrachytherapy seed of each pocket includes isotopes selected from thegroup consisting of cesium and iodine.
 6. The surgical buttressaccording to claim 1, wherein the surgical buttress is formed with atleast one marking provided at least one of in or on the body portion. 7.A method of embedding radioactive material into a surgical buttress,comprising: providing a surgical buttress; providing a template holdingthe radioactive material; and mating the template to the surgicalbuttress.
 8. The method of claim 7, wherein providing a surgicalbuttress further includes providing a surgical buttress comprising aplurality of pores.
 9. The method of claim 7, wherein providing atemplate includes providing a template holding brachytherapy seed. 10.The method of claim 9, wherein the brachytherapy seeds include one ofiodine and cesium isotopes.
 11. The method of claim 7, wherein theradioactive material is disposed on at least 10% of a surface area ofthe buttress.
 12. The method of claim 7, wherein the radioactivematerial is applied to one of the lateral sides and the outer side ofthe surgical buttress.
 13. A kit for performing surgical stapling,comprising: a surgical stapling instrument; at least one surgicalbuttress; and a package of encapsulated radioactive material.
 14. Thekit of claim 13, wherein the surgical stapling instrument is a surgicalstapling loading unit.
 15. The kit of claim 14, wherein the loading unitis a removable and replaceable staple cartridge assembly.
 16. The kit ofclaim 15, wherein the at least one surgical buttress is pre-loaded ontothe surgical stapling instrument.
 17. The kit of claim 13, wherein theat least one surgical buttress includes pockets.
 18. The kit of claim17, wherein the buttress has lateral sides that include the pockets. 19.The kit of claim 18, wherein the lateral sides are wings that extendbeyond the sides of the surgical stapling instrument.
 20. The kit ofclaim 13, wherein the encapsulated radioactive material is brachytherapyseeds.
 21. The kit of claim 20, wherein the brachytherapy seeds haveisotopes of cesium or iodine.
 22. The kit of claim 13, wherein thepackage has shielding.
 23. The kit of claim 13, wherein the package hasa template and the encapsulated radioactive material is attached to thetemplate.